Friday, 1 Jul 2022

Diabetes: Taking metformin before conceiving could increase risk of birth defects by 40%

Dr David Lloyd discusses using diabetes drug for anti-aging

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Metformin works by targeting the high blood sugar levels that characterise diabetes, and its unparalleled efficacy has gained recognition across the world. What’s more, some research has suggested the medication may increase life expectancy by improving the body’s responsiveness to insulin, antioxidants effects, and improving blood vessels. Other findings, however, have prompted a discussion about the drug’s safety for men trying to have children.

The latest study, published in the Annals of Internal Medicine, has found a significantly increased risk of genital birth defects among boys whose father had filled a prescription for Metformin roughly three months prior to conception.

The study’s three-month time frame was decided because it allowed fertilising sperm to fully mature.

According to the findings, the drug may cause genital birth defects such as undescended testicles and urethral problems.

What’s more, it appeared to affect sperm that developed within the three months before the baby was conceived.

READ MORE: NHS Diabetes Prevention Programme: Lifestyle advice ‘can cut risk of diabetes by 40%’

There was no evidence that female children are affected by these alterations to the father’s sperm.

The study’s co-author, Maarten Wensink, a public health expert at the University of Southern Denmark, said the findings presented a strong case to “put more priority on paternal health”.

The findings were obtained after examining the medical records of children born between 1997 and 2016, whose fathers took metformin or other diabetes-related medication.

Records were only included for children whose mothers were not prescribed any diabetes medication, or diagnosed with the disease.

A total of 1.1 million children had their records analysed, and findings showed that 3.3 percent of the cohort had at least one major birth defect.

In children with paternal exposure to metformin during the conception period, however, the frequency of birth defects rose to 5.3 percent.

Only birth defects affecting the genitals were observed in babies born to fathers taking metformin.

What’s more, men who took the drug before or after the three-month period did not have an increased risk of having a baby with birth defects.

Germain Buck Louis, a reproductive and perinatal epidemiologist at George Mason University, said previous research had produced evidence to explain these findings.

It had previously been suggested that “altered testosterone levels may be an underlying mechanism raising concern about the anti-androgenic activity of oral diabetes pharmacologic agents, including metformin”.

The expert told MedPage: “The fact that the risk associated with one specific paternal medication during the specific window when sperm would lead to pregnancy is developing surprised us.

“There are papers on fish and rats where metformin affects the male reproductive system, but such findings may not carry over into humans, and these papers did not focus on sperm development.”

The FDA does not currently advise against metformin use for men trying to conceive, but Mr Wenskin told Reuters that men may benefit from switching drugs before trying to conceive.

However, he noted: “If patients would like to switch to an alternative, they should contact their doctor.”

The researcher added that lifestyle interventions, in the form of dietary changes and weight loss, could go a long way to help treat diabetics.

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